How does Psoriasis affect the skin?
Psoriasis is a condition of the skin which is complex, chronic and substantially affects the skin’s appearance, texture and general health. It’s way more than just a superficial skin issue, it’s a multifaceted autoimmune disorder that has systemic implications. In this article, we examine how and why psoriasis influences the skin and how it affects general health and quality of life.
Do you or someone you know have Psoriasis? Our skin is our largest organ and a reflection of our internal health. Watch our video to learn “How does Psoriasis affect the body“.
Understanding Psoriasis
Psoriasis is a chronic, autoimmune condition that causes the body to speed up the life cycle of skin, causing skin cells to grow and multiply abnormally fast. Psoriatic skin cells do all this — mature, form and shed — in about three to four days, compared to the month it takes normal skin cells to do the same. This leads to skin cell buildup resulting in thick, scaly patches of skin called plaques. They can appear in different places, from the scalp down to the elbows, knees, lower back and anywhere else on the body.
There are several types of psoriasis, each affecting the skin in distinct ways:
- Plaque Psoriasis (Psoriasis Vulgaris)
Raised, red patches covered with silvery white scales, the most common type.
- Guttate Psoriasis
They appear as small, drop-shaped sores on the skin, which is most often caused by infections, like strep throat.
- Inverse Psoriasis
Causes shiny red lesions in skin folds, including under the breasts or around the groyne.
- Pustular Psoriasis
It consists of white pustules (blisters filled with pus) in an inflamed area of skin.
- Erythrodermic Psoriasis
A form that can be severe and very rare which leads to widespread redness, peeling, and severe itching or burning.
The Pathophysiology of Psoriasis
At its core, psoriasis is caused by an overactive immune system. Normally our immune cells fight off infections. But in psoriasis, these cells attack healthy skin cells, causing inflammation and accelerated cell turnover. It also causes the dilation of blood vessels to increase blood flow to areas affected by the immune response, and contribute to redness and warmth.
T cells, a type of white blood cell; and inflammatory cytokines, like interleukin-17 (IL-17) and tumour necrosis factor alpha (TNF-alpha) are the key players in psoriasis. These substances feed the inflammatory process, keeping the cycle of the overproduction and accumulation of the skin cells going.
How Psoriasis Manifests on the Skin
Psoriasis affects the skin in several visible and tangible ways:
Redness and Inflammation
Redness and swelling are produced by the immune system’s attack on skin cells. Plaque and inverse psoriasis are particularly prone to show these symptoms.
Scaling and Flaking
Thick, scaly patches are formed by a rapid buildup of skin cells. Often silvery white and may shed, causing them to flake.
Thickened Skin
Repeated cycles of inflammation and healing causes skin to thicken, usually in areas of the skin damaged by repetitive scratching or friction.
Itching and Pain
The itch can be so intense that people scratch psoriatic plaques, and this may worsen inflammation and injure the skin. It is also common to have pain, which happens often in very severe cases, or in areas of sensitive skin.
Cracking and Bleeding
This can cause the skin to become dry and thickened and cracked, eventually leading to bleeding and potential infection.
Color Changes
Once the flare up goes away, the area of affected skin might appear darker or lighter than surrounding areas and is called post-inflammatory hyperpigmentation or hypopigmentation.
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Specific Areas of the Body Affected by Psoriasis
While psoriasis can appear anywhere on the skin, certain areas are particularly prone to symptoms:
Scalp
Thick scales that flake off like dandruff can develop on the scalp from psoriasis. It can go from the hairline to the forehead, neck and ears.
Hands and Feet
These areas can develop psoriasis leading to painful cracks and blisters which in turn can make a person’s daily activities difficult.
Nails
The nails can also be affected by psoriasis, leading to pitting, thickening, discolouration and separation from the nail bed (onycholysis).
Skin Folds
Inverse psoriasis tends to attack those areas where skin is rubbing against itself such as under the breasts, around the groyne and under the buttocks. Irritation and secondary infections in these areas are common.
The Emotional and Psychological Impact
Emotional well being can suffer from the visible nature of psoriasis. Because of the appearance of psoriasis, many suffer with anxiety, depression, and social stigma. And, of course, it’s not just uncomfortable, it can cause itching and disrupt your sleep, which in turn compounds the effects on mental health and overall quality of life.
Psoriasis Beyond the Skin
Psoriasis is mainly a skin disorder but it affects other parts of your body as well. People with psoriasis are at increased risk for several comorbidities, including:
About 30% of people with psoriasis go on to develop PsA, which is a condition in which the joints become inflamed, painful, stiff and swollen.
Cardiovascular Disease
Psoriasis can cause long-term inflammation that might lead to atherosclerosis and raise the risk for heart attacks and strokes.
Metabolic Syndrome
Obesity, diabetes, and hypertension are associated with psoriasis, all parts of metabolic syndrome.
Mental Health Disorders
People with psoriasis are more likely to be depressed or anxious and the stress is often due to the condition’s physical and social effects.
Managing Psoriasis
Psoriasis is something that can be managed naturally by a combination of remedies, dietary changes and lifestyle changes. Oatmeal baths and aloe vera can help soothe symptoms and reduce inflammation which are natural remedies. For skin health and well being, include anti-inflammatory foods like dark leafy greens, berries, fatty fish and whole grains. Trigger foods such as processed meats, sugary snacks, foods high in unhealthy fats and sodium should be avoided because they may make inflammation worse. Stress management techniques, staying hydrated, and regular exercise can also make psoriasis management even better.
The Importance of Individualized Care
Psoriasis is highly individual and very different symptoms and triggers can occur in patients. As a result, treatment should be tailored. Healthcare providers bridge the gap between the patient and the healthcare community, identifying triggers, optimising treatment regimens for patients, and addressing related health issues.
Watch our video where Petrina answers the question, “How does Psoriasis affect quality of life?“
Conclusion
Psoriasis is a disease that runs deeper than our skin— patients experience a chronic, systemic disease which deeply impacts physical and emotional health. Proper management of psoriasis is possible by helping people and healthcare providers to understand how psoriasis affects the skin and the underlying mechanisms. Research and treatment has made great advances which offer hope of better symptom control and better quality of life for people with psoriasis.
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To learn more about Psoriasis, check out our other related blogs:
Can Psoriasis Affect Other Parts Of The Body Beside The Skin?
Are any other conditions linked to Psoriasis?
What Does Psoriasis Look Like?
What Is The Link Between Psoriatic Arthritis And Plaque Psoriasis?
Are there different types of Psoriasis?
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